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Peritoneal dialysis is a widely used treatment for kidney failure; however, peritoneal dialysis-related infections (exit-site, tunnel infection, peritonitis) occur frequently. The effect of standardised nurse and patient training on peritoneal dialysis infections is uncertain. The aim of this study was to determine whether implementing an international guideline-based standardised training curriculum for nurse trainers and new peritoneal dialysis patients reduces the risk of peritoneal dialysis-related infections compared with existing local training practices. Targeted Education ApproaCH to improve Peritoneal Dialysis (TEACH-PD) was a pragmatic, investigator-initiated, cluster-randomised controlled trial conducted in Australia and New Zealand. Adult patients 18 years of age or older with kidney failure who required training for incident peritoneal dialysis treatment and who were able to provide written informed consent were eligible. Clusters were randomised 1:1 to either the standardised training curriculum or usual care. Participant data and infection outcomes were routinely collected in national patient registries. The primary outcome was time to first peritoneal dialysis-related infection (exit site infection, tunnel infection, or peritonitis). Secondary outcomes were the first of each individual infection type in the primary composite outcome, catheter removal, haemodialysis transfer, all-cause death and quality of life. This trial was registered with ClinicalTrials.gov, number NCT03816111. Between 22 July 2019 and 29 September 2023, 42 clusters were randomised: 21 to the standardised training group and 21 to the usual care group. Overall, 1462 incident peritoneal dialysis patients were included; 667 were assigned to the standardised training group and 795 to the usual care group. A peritoneal dialysis-related infection occurred in 296 of 667 patients in the standardised training group and 297 of 795 patients in the usual care group (sub-hazard ratio 1.230, 95% confidence interval [CI] 1.004-1.507, p = 0.0457). Secondary outcomes were similar in the two groups. Among patients commencing peritoneal dialysis, the use of a standardised training curriculum for nurses and patients based on the International Society for Peritoneal Dialysis guidelines increased peritoneal dialysis-related infection. Implementation-focused research is needed to identify which elements of training require standardisation and where individualisation is most beneficial to support safe, sustainable and patient-centred peritoneal dialysis care. The TEACH-PD trial is funded by MRFF Clinical Trials Activity: Rare Cancers, Rare Diseases and Unmet Need Grant Opportunity; National Health & Medical Research Council BEAT-CKD Program Grant; Health Research Council of New Zealand grant; Metro South Health Research Support Scheme Research Fund-Health System and Health Economics Project Grant; Queensland Health; South Western Sydney Research Small Grant Scheme; International Society for Peritoneal Dialysis; Translational Research Institute Australia; Amgen and Baxter Healthcare (Vantive).
Extracorporeal shock wave therapy (ESWT) may improve pain and function in patients with calcaneal spur; however, outcomes may vary according to patient characteristics. This study aimed to identify clinical, functional, radiological, and physical activity-related predictors of treatment response in individuals with calcaneal spur who received ESWT and to assess the extent of improvement after treatment. Retrospective observational study using a single-assessment retrospective pretest-posttest design. A total of 120 patients who underwent ESWT for heel pain/plantar fasciitis associated with calcaneal spur and who had complete study data were included. Participants completed a single post-treatment telephone interview, reporting their current status and retrospectively recalling their pre-treatment status. Assessments included Numerical Rating Scale scores for first-step pain and total heel pain, Roles and Maudsley Scale scores, Foot Function Index scores, International Physical Activity Questionnaire-Short Form scores, analgesic consumption, calcaneal spur size, and radiological stage. Significant improvements were observed in pain and foot-related functional measures following ESWT. The percentage of patients utilizing analgesics decreased from 64.2% to 31.7%. IPAQ-SF (International Physical Activity Questionnaire-Short Form)/MET (Metabolic Equivalent of Task)-based scores for walking, moderate-intensity activity, vigorous activity, and total physical activity increased significantly after ESWT. ESWT may reduce pain and analgesic use while improving function and physical activity in patients with calcaneal spur. Patient-related, radiological, functional, and physical activity-related factors were associated with the degree of treatment benefit. Level IV, retrospective observational study.
Over recent decades, non-pharmacological pain management approaches have gained increasing importance in pediatric care, as they can be applied with low cost and minimal time investment while significantly contributing to the improvement of care quality. The aim of this review article is to provide an overview of non-pharmacological options for procedural pain management based on the literature, and to present the dissemination of this approach in Hungary through the support of a child-centered, trust-based healthcare model. This paper presents a narrative review of the key findings of international literature on non-pharmacological management of procedural pain. In addition, it describes the practical implementation of an interdisciplinary non-pharmacological pain management program based on the principles of the Comfort Promise, which has been operating since 2021 at the Bethesda Children's Hospital of the Hungarian Reformed Church. The article outlines the steps of implementation, the tools and techniques applied, and summarizes clinical experiences. Methods shown to be effective in the literature - such as distraction, breathing exercises, comfort positioning, breastfeeding, and the use of various sensory tools - are, in line with international evidence, also supported by clinical experience as contributing to the reduction of children's anxiety, increasing parental satisfaction, and improving the quality of care. Experience suggests that integrating non-pharmacological methods into everyday clinical practice does not require significant additional resources; however, it does necessitate a shift in mindset and a structured implementation process. Interdisciplinary collaboration, staff training, the establishment of a volunteer network, and the active involvement of parents and children are key factors for sustainable implementation. Based on current experience, the combined application of this approach and its methods has proven to be effective. According to international literature, anxiety-reducing interventions - including parental presence, appropriate information provision, distraction, and relaxation techniques - contribute to the alleviation of procedural pain through neural mechanisms influencing pain perception, which is also supported by the institutional experience presented. Orv Hetil. 2026; 167(31): 1215-1223. Az elmúlt évtizedekben a nem gyógyszeres fájdalomcsillapító eljárások egyre nagyobb szerepet kapnak a gyermekellátásban, mivel kis költséggel és csekély időráfordítással alkalmazhatók, ugyanakkor jelentős mértékben hozzájárulhatnak az ellátás minőségének javításához. A jelen összefoglaló közlemény célja a procedurális fájdalomkezelés nem gyógyszeres lehetőségeinek áttekintése a szakirodalom mentén, valamint a szemlélet hazai elterjedésének bemutatása egy gyermekközpontú, bizalomra épülő egészségügyi ellátási modell támogatásával. A közlemény narratív áttekintés formájában ismerteti a procedurális fájdalom nem gyógyszeres kezelésére vonatkozó nemzetközi szakirodalom főbb megállapításait, továbbá ismerteti a Magyarországi Református Egyház Bethesda Gyermekkórházában 2021 óta működő, a Comfort Promise alapelveire épülő interdiszciplináris nem gyógyszeres fájdalomkezelési gyakorlat megvalósítását. Bemutatja a bevezetés lépéseit, az alkalmazott eszközöket és technikákat, valamint összefoglalja a klinikai tapasztalatokat. A szakirodalomban hatékonynak bizonyuló eljárások – így a figyelemelterelés, a légzőgyakorlatok, a kényelmes pozicionálás, a szoptatás, valamint a különböző szenzoros eszközök alkalmazása – a nemzetközi evidenciákkal összhangban a klinikai tapasztalatok alapján is hozzájárulnak a gyermekek szorongásának csökkentéséhez, a szülői elégedettség növeléséhez és az ellátás minőségének javításához. Tapasztalatok alapján a nem gyógyszeres módszerek integrálása a mindennapi klinikai gyakorlatba nem igényel jelentős többleterőforrást, ugyanakkor szemléletváltást és strukturált bevezetést tesz szükségessé. Az interdiszciplináris együttműködés, a személyzet képzése, az önkéntes hálózat kiépítése, valamint a szülők és gyermekek aktív bevonása kulcsfontosságú az implementáció és a fenntarthatósága szempontjából. Az eddigi tapasztalatok alapján a szemléletmód és a módszerek kombinált alkalmazása eredményes megközelítésnek bizonyult. A nemzetközi szakirodalom alapján a szorongáscsökkentést célzó módszerek – beleértve a szülői jelenlétet, a megfelelő tájékoztatást, a figyelemelterelést és a relaxációs technikákat – a fájdalomélményt befolyásoló neuralis mechanizmusokon keresztül hozzájárulnak a procedurális fájdalom mérsékléséhez, amit a bemutatott intézményi gyakorlat tapasztalatai is megerősítenek. Orv Hetil. 2026; 167(31): 1215–1223.
To evaluate which imaging biomarkers in uveitis have approached clinical utility, which remain incompletely validated, and how consensus frameworks and artificial intelligence are reshaping the path toward standardized, decision-useful assessment. Quantitative optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) metrics have gained disease-specific precision. Anterior segment OCT particle-size analysis differentiates inflammatory cells from pigment with high discriminative performance. OCTA vessel density tracks chronic microvascular loss in birdshot chorioretinopathy more reliably than it captures real-time inflammatory activity. Choroidal vascularity index shows promise as a subclinical choroidal marker, though cross-platform standardization remains unresolved. The multimodal uveitis (MUV) international taskforce has established consensus minimal imaging sets for five white dot syndromes, providing the first systematic effort to define which modality is essential for diagnosis, activity monitoring, and complication detection in specific entities. Artificial intelligence applications have demonstrated proof-of-concept performance, but translation is constrained by small datasets and absent prospective validation. Most proposed imaging biomarkers remain disease-specific and incompletely validated. Recent quantitative approaches and international consensus frameworks may narrow the gap between descriptive imaging and actionable, trial-ready biomarkers. The bottleneck has shifted from image acquisition to validation, harmonization, and integration with clinical outcomes.
Gliomas are the most common primary malignant tumors of the central nervous system. Their incidence and survival vary across low/middle and high-income countries. This study summarizes the epidemiological, clinical, and therapeutic features of a Moroccan cohort, based on the WHO 2021 classification. We conducted a retrospective descriptive single-center study at the Mohammed VI Cancer Center in Casablanca, including 122 patients with diffuse infiltrating gliomas diagnosed between January 2019 and November 2024. Demographic, clinical, and therapeutic data were analyzed. Overall survival was assessed in 64 glioblastoma patients using Kaplan-Meier methods, log-rank tests, and Cox regression models. Among 122 patients, the median age was 56 years with a 2:1 male to female ratio. Glioblastoma was the predominant subtype (75%), localized predominantly in the parietal (31%), frontal (26%), and temporal (21%) lobes. The frequently observed symptoms were motor deficits, headaches, and seizures. For glioblastoma patients, the median OS was 9 months, with a 2-year survival rate of 27%. Younger age and multimodal treatment were associated with better outcomes, with treatment emerging as the only independent prognostic factor. Our institutional clinicopathological features align with international series, whereas overall survival stands lower. Patients receiving full multimodal therapy achieved survival profiles comparable to published international data, identifying treatment as a determinant of outcome in our setting. Expanded molecular testing and structured clinical follow-up represent potential strategies to optimize survival outcomes within our institutional context.
This study evaluated the radioactivity levels and associated radiological health risks of groundwater surrounding a coal-based super thermal power plant in Jhajjar district, Haryana, India. A total of seventy groundwater samples were gathered from thirty-five locations within a 20 km radius, along with five background sites located beyond that distance and were analysed for 40K, 238U, and 232Th using a Sodium Iodide, Thallium-activated (NaI (Tl)) scintillation detector. The activity concentrations in the 20 km area varied from 0.11 to 37.72 Bq/L for 40K (with an average of 8.14 ± 0.37 Bq/L), 0.01 to 3.13 Bq/L for 238U (average 0.82 ± 0.07 Bq/L), and 0.01 to 3.52 Bq/L for 232Th (average 0.45 ± 0.04 Bq/L). These levels were notably higher than the regional background levels measured beyond 20 km. The Annual Effective Dose and the Excess Lifetime Cancer Risk derived from radiological parameters showed the variation from 0.047 to 0.489 mSv y⁻1, and 1.64 × 10⁻4 to 17.12 × 10⁻4 respectively. Approximately 60% of the groundwater samples exceeded the WHO (2017) guideline value for uranium (238U; 0.5 Bq/L), while about 40% exceeded the World Health Organization (WHO, 2017) reference level for Total Annual Effective Dose from drinking water (0.1 mSv y⁻1). Furthermore, five sampling locations (W14, W17, W 18, W19 and W21) exceeded the International Commission on Radiological Protection (ICRP, 2007) benchmark for Excess Lifetime Cancer Risk (1 × 10⁻3). The elevated radionuclide concentrations within the 20 km radius were likely influenced by fly ash dispersion from the thermal power plant, as inferred from spatial, statistical, and wind-direction patterns, in addition to natural contributions from the regional geology. These results set a quantitative radiological baseline for the study area and showed how important it is to regularly check the groundwater to make sure it meets international radiological safety standards.
This paper aims to evaluate the perceived value of the drug prevention activities in Malaysia's high-risk areas. The drug prevention activities involved are counseling, outreach, workshop, and program. A quantitative method is employed in this study to investigate the participants' perception on the programs. A cross-sectional survey of 332 participants across seven selected high-risk regions in Peninsular Malaysia were selected for their proximity to international borders and high drug-related crime statistics. The results revealed compelling insights, showing that emotional and social values were strongly correlated with program effectiveness, while functional value showed only marginal influence. These findings challenge conventional policy approaches by demonstrating that community-based interventions fostering emotional support networks and social cohesion yield substantially greater impact than traditional information-driven or enforcement-focused strategies. The study also has theoretical contributions by validating the applicability of perceived value theory in substance abuse prevention contexts, while offering practical recommendations for policymakers to redesign interventions with greater emphasis on psychosocial support mechanisms. Limitations include the cross-sectional design and regional focus, suggesting opportunities for future longitudinal studies across broader geographical areas to assess program sustainability and cultural adaptability.
Prostate biopsy for histological confirmation is the standard before radical prostatectomy (RP). However, some patients refuse biopsy despite highly suspicious imaging findings. This study aimed to evaluate final pathology, assess potential active surveillance (AS) eligibility, and exploratorily evaluate perioperative outcomes and short-term oncological biochemical recurrence (BCR)-free survival after biopsy-naïve RP (bnRP). We retrospectively analyzed a single-center cohort of patients who underwent bnRP with pT2-pT3 disease between 2019 and 2026. Final pathology was assessed, and potential AS eligibility was approximated using European Association of Urology-based low-risk and favorable intermediate-risk categories. Perioperative outcomes and short-term BCR-free survival were exploratorily compared between patients who underwent bnRP and those who underwent biopsy-confirmed RP (bcRP) using Kaplan-Meier estimation, log-rank testing, and a univariable Cox proportional hazards model. In 103 consecutive bnRP specimens, prostate cancer was confirmed in all patients. Overall, 94% had clinically significant prostate cancer (csPCa). Compared with 3081 consecutive patients who underwent bcRP, patients who underwent bnRP had fewer low-grade tumors and more locally advanced disease. Overall, 5.8% of the biopsy-naïve patients had International Society of Urological Pathology grade group 1 disease, but only one patient fulfilled the stricter AS approximation criteria. However, in total, 18% of the biopsy-naïve patients fulfilled broader AS criteria and might have warranted formal AS assessment. Exploratory analysis revealed no significant difference in short-term BCR-free survival between patients who underwent bnRP and those who underwent bcRP. In our single-center observational analysis of carefully selected patients, bnRP seemed safe and was associated with a high likelihood of csPCa. Nevertheless, the retrospective approximation of AS eligibility highlights that bnRP should be performed cautiously. Exploratory perioperative and short-term oncological analyses need prospective validation.
NTM soft tissue infection outbreaks in Venezuela (2006) exposed failures of locally marketed high-level disinfectants (HLDs), with only international products meeting standards. After renewed NTM outbreaks in 2024, we re-evaluated locally manufactured products claiming HLD, sterilant, or sporicidal activity. We collected 14 locally marketed disinfectants: 11 labeled HLD and three labeled intermediate-level. Active ingredients included QACs, glutaraldehyde, organic acids, alcohols, and a strong base. Efficacy was tested using EN 14348 (mycobactericidal) and EN 17126 (sporicidal) under clean and dirty conditions. HLD required ≥4-log10 spore reduction; intermediate-level required 4-log10 mycobacteria reduction. Only one glutaraldehyde-based product met HLD criteria. Three correctly labeled intermediate-level disinfectants showed mycobactericidal activity under both conditions. One HLD-labeled product demonstrated only mycobactericidal activity, warranting reclassification as intermediate-level. All other products failed, especially under organic load, and should be classified as low-level disinfectants. Despite label claims, most locally marketed disinfectants failed efficacy standards, revealing a critical regulatory gap. For hospital disinfection, we recommend product selection rely on independently verified efficacy data, not manufacturer claims. Similar deficiencies likely exist elsewhere, underscoring the need for systematic regional testing to ensure effective infection control.
Resistant hypertension poses significant management challenges in primary care, with varying practices influencing patient outcomes. We evaluated current practices of primary care physicians in Singapore in managing resistant hypertension and examined their concordance with local and international guidelines. An anonymised cross-sectional survey was conducted from July 2021 to October 2023, using a 26-item questionnaire distributed to primary care physicians across Singapore. The survey included physicians from both the public and private healthcare sectors, while specialists were excluded. The survey assessed their knowledge of the definitions, diagnostic criteria, treatment preferences and referral patterns for resistant hypertension. A total of 85 respondents participated in the survey. Only 74% (n = 63) of respondents correctly defined resistant hypertension as uncontrolled blood pressure (BP) (above 140/90 mmHg) despite concurrent use of three or more antihypertensives, including a diuretic. In addition, 53% (n = 45) correctly defined uncontrolled hypertension as home BP exceeding 135/85 mmHg. The majority (69%, n = 59) of primary care physicians would consider referral to a specialist after a trial of three antihypertensives, whereas 13% (n = 14) chose to continue management in primary care. Referrals were made mainly to Endocrinology (43%, n = 47) and Cardiology (35%, n = 39). Notably, few primary care physicians (27%, n = 23) considered the necessary work-up for secondary causes such as primary aldosteronism. This study identifies discrepancies between clinical practice and guidelines. The findings highlight a need to improve education on accurate definitions and guideline-based diagnosis of resistant hypertension, and develop clear national referral pathways for suspected secondary hypertension in primary care.
The Best of the European Society of Gynaecological Oncology 2026 review highlights a selection of the best original research presented at the 27th Congress of the European Society of Gynaecological Oncology, held February 26 to 28, 2026, in Copenhagen, Denmark. Of the 1585 abstracts submitted, the ESGO Scientific Programme Committee chairs and authors from the European Network of Young Gynae Oncologists selected 31 high-impact studies for inclusion in this compilation. This included 10 Best Oral Sessions abstracts, 10 Mini Oral Sessions abstracts, 9 Young Investigator Session abstracts, and 2 Best 3-Minute Presentations abstracts. Key research themes this year included implementation of updated European Society of Gynaecological Oncology ovarian and endometrial cancer guidelines, refinement of surgical strategies in advanced and recurrent ovarian cancer, advances in immunotherapy and non-chemotherapy combinations, biomarker testing and personalized surgery as part of precision oncology, human epidermal growth factor receptor 2-directed therapies and antibody-drug conjugates, management of rare tumors, and innovations in prevention, diagnosis, and cervical cancer care. Through this initiative, European Society of Gynaecological Oncology and European Network of Young Gynae Oncologists aim to showcase the most impactful developments in gynaecologic oncology research and to facilitate their dissemination to clinicians, researchers, patients, advocacy groups, and allied professionals across Europe and internationally.
Access block is defined as a delay in access to inpatient beds for patients from the Emergency Department (ED). It is a key contributor to ED overcrowding and is associated with worse patient outcomes. This study aimed to quantify access block within Chris Hani Baragwanath Academic Hospital's Trauma Emergency Unit (TEU) and identify associated factors. A retrospective review was conducted of all consecutive patients presenting to the TEU resuscitation room from January 1 to December 31, 2022. Patients aged <14 years (<10 for burns) and those managed by other services were excluded. Data on demographics, clinical characteristics, resuscitation length-of-stay, interventions, and disposition were analysed. Access block was defined as a >8 h delay for the purposes of this study. Univariable analyses were performed to identify associations with access block. During the study period, 2270 patients were admitted from the resuscitation room to the ward without first requiring the operating theatre, of whom 2091 had a recorded length-of-stay. Access block affected 61.3%. In unadjusted analysis, factors significantly associated with access block included a requirement for CT imaging (OR 4.17), intensive care unit (ICU) admission (OR 3.69), mechanical ventilation (OR 2.10), blunt mechanisms of injury (OR 2.19), presenting at night (OR 1.85), and an arrival shock index ≥1 (OR 1.32). Conversely, presenting with penetrating trauma (OR 0.61), burns (OR 0.50), and undergoing intercostal catheter insertion (OR 0.53) were associated with significantly lower odds of access block. Time-to-CT was significantly longer in patients with access block (366 vs 165 min; P < 0.01). Patients requiring mechanical ventilation had significantly longer length-of-stay (834 vs 631 min; P < 0.01), even once time-to-CT was accounted for. Most admitted patients were affected by access block. Associated factors included CT imaging, ICU admission, mechanical ventilation, and presentation at night. This corroborates the international consensus that whole-of-system solutions are necessary to remedy it.
Volume-targeted ventilation (VTV) is an evidence-based, lung-protective strategy demonstrated to reduce the incidence of bronchopulmonary dysplasia (BPD) and severe neurologic injury in premature infants. While variations in VTV adoption are well-documented in North America and Europe, data characterizing its utilization across the broader Middle East remains limited. To evaluate the utilization rates of VTV, the selection of tidal volume (VT) targets across various clinical scenarios, and the perceived barriers to VTV implementation among practicing neonatologists in the United Arab Emirates (UAE). A cross-sectional survey was distributed to practicing neonatologists across multiple regions in the UAE. The survey assessed clinician and unit characteristics, core ventilation practices, scenario-based VT targeting, and barriers to VTV implementation. A total of 94 responses were analyzed. VTV was the most commonly reported invasive mode, with 78 (84.8%) of respondents classified as regular VTV users. VTV was predominantly utilized across both the acute and weaning phases of ventilation, with 60 (64.5%) respondents reporting its use. The reported median VT limits ranged from 4.0 to 6.0 mL/kg. Scenario-based responses revealed a median initial VT target of 5.0 mL/kg for a 500-g, 24-week infant with respiratory distress syndrome (RDS), 5.0 mL/kg for a term infant with meconium aspiration syndrome (MAS), and 4.0 mL/kg for an infant with congenital diaphragmatic hernia (CDH). High-frequency oscillatory ventilation (HFOV) was widely used (78, 97.5%); however, the use of volume guarantee (VG) during HFOV remained uncommon (28, 36.4%). Regular VTV use was significantly associated with ≥10 years of experience (P = 0.011) and practice in an academic/training level III NICU (P = 0.021). Unlike North American cohorts, the primary reported barrier to VTV adoption in the UAE was equipment unavailability rather than a lack of clinical understanding. The UAE demonstrates a high rate of VTV adoption, aligning with the most progressive international benchmarks. However, scenario-specific VT targeting reveals a tendency to default to standard volumes regardless of the underlying lung pathophysiology. Continued efforts should focus on optimizing equipment availability and providing targeted education on individualizing VT settings to further elevate neonatal respiratory care.
Background Document control is a core requirement of laboratory quality management and accreditation, including under the College of American Pathologists (CAP), International Organization for Standardization (ISO) 17025, ISO 15189, the Association for the Advancement of Blood & Biotherapies (AABB), and the Central Board for Accreditation of Healthcare Institutions (CBAHI). Before 2024, many Saudi laboratories relied on paper-based systems or imported platforms that lacked Arabic-language functionality, local hosting, and explicit alignment with Saudi regulatory and governance requirements. Objective To describe the development, standards-based internal validation, and early multisite implementation of the Makeen Document Control System (Makeen DCS), a Saudi-built laboratory document control platform designed for accreditation-oriented use in Saudi Arabia, and to assess early feasibility and user-perceived acceptability rather than comparative effectiveness. Methods This descriptive implementation and feasibility study was conducted from October 2024 to January 2026. System requirements were derived from CAP, ISO 17025, ISO 15189:2022, AABB, CBAHI, FDA 21 CFR Part 11, and Saudi Personal Data Protection Law (PDPL) requirements and translated into software specifications. Development followed staged requirements definition, prototyping, workflow refinement, internal validation, and pilot deployment. Internal validation used 126 structured test cases across user access, document creation and upload, approval workflow, version control, retrieval, audit trail behavior, and administrative functions. Early implementation was undertaken in seven purposively selected pioneer laboratory sites. User feedback was collected through an internally developed implementation survey completed by eight participants from pilot sites. Results The Makeen DCS provided end-to-end document lifecycle management, role-based access control, bilingual Arabic-English interfaces, dynamic master document lists, searchable retrieval, audit-oriented reporting, and a personnel-documentation module. The system supported both Saudi-hosted cloud deployment and on-premises implementation. Functional alignment was mapped against selected CAP, ISO 17025, ISO 15189:2022, CBAHI, AABB, FDA Part 11, and PDPL requirements. Among 126 validation test cases, 109/126 (86.5%) passed on first execution, and 17/126 (13.5%) failed initially; all failed items were corrected and retested, resulting in a final pass rate of 100% (126/126). Early deployment was achieved across seven diverse sites, of which six were fully active, and one remained partially implemented by study cut-off. Median active users across sites were 80 (range: 30-200), median configured departments were 10 (range: 5-15), and median migrated or newly created controlled documents were 76 (range: 10-274) across six sites with available data. User feedback was favorable, with a mean satisfaction score of 9/10, 7/8 (87.5%) respondents willing to recommend the platform, and 8/8 (100.0%) perceiving improved inspection readiness and reduced manual or paper-based workload. Conclusions Makeen DCS was feasible as a Saudi-built/bilingual/locally hosted lab platform for accreditation workflows. Internal validation, pilot use, and small-sample feedback show readiness/acceptability, not operational effectiveness; independent longitudinal evaluation is needed.
Cardio-pulmonary resuscitation (CPR) is an essential skill that all health providers must master. Simulation training on traditional manikins in a normal classroom does not prepare the trainees for the stress that could reduce the resuscitation performance of especially inexperienced providers during a real cardiac arrest. The aim of this randomized cross-over trial was to explore whether training using augmented reality (AR) was realistic enough to induce stress and impact the resuscitation skills of doctors of different experience levels. Novices, intermediates, and experienced physicians participated in this single-center, randomized, cross-over, simulation-based study. All participants had to perform CPR on a high-fidelity manikin with and without AR. In the immersive AR environment, sounds from multiple sources and visuals of bustling crowds were used to simulate a stressful environment. The State-Trait Anxiety Inventory (STAI) were used to measure the participants' perceived stress levels during the simulation sessions. Frequency and depth of chest compressions, and the ratio of chest compression time to the entire recovery cycle, i.e. the Chest Compression Fraction (CCF) were used to objectively measure the quality of the resuscitation. Trial Registration: not applicable. This study included 80 participants, novices=28, intermediates=27, and experienced=25. The novices reported significantly more stress during the AR simulation while participants with a higher level of experience were less affected by the stressful environment induced by the AR system. All three groups performed significantly worse regarding compression depth when they were in the stressful AR environment. Overall, 66 (83%) participants used the correct compression rate in the standard environment vs. 44 (55%) in the AR induced stressful environment, p<0.001; only the experienced did not perform significantly worse, p=0.36. The CCF increased significantly from 56% to 60% when performing resuscitation while using AR, indicating slightly better adherence to international recommendations. AR successfully added stress to performance of resuscitation in a simulated environment. It made it difficult for participants to achieve accurate depth of compression under pressure and the inexperienced also performed worse regarding compression rate and reported feeling more stressed. Training resuscitation using AR might prepare health care providers for the stressful situations of a clinical cardiac arrest.
The sand lizard (Lacerta agilis) is an endangered native species in England, typically persisting in small, fragmented populations. A conservation translocation (reintroduction) programme has contributed to recovery by establishing new populations and regaining the lost range of the species. The translocation of wild animals has been associated with severe epidemic disease giving rise to extinctions, and therefore, caution is required in the planning of future translocations. In line with International Union for the Conservation of Nature recommendations, a disease risk analysis was conducted on the sand lizard reintroduction programme in 2003. A disease outbreak, associated with the bacterium Serratia marcescens, occurred in a sand lizard colony being prepared for reintroduction in 2004, and S. marcescens had not previously been recorded in reptiles in England. In order to reassess disease risk management methods, efforts were made to establish whether this bacterium was a naturally occurring species in UK sand lizards, and a survey was conducted on 194 free-living, wild sand lizards from a population that had not received reintroduced sand lizards. Cloacal swabs, collected from the free-living sand lizards, were cultured for bacteria, and S. marcescens was recorded at 1.5% prevalence (n = 194). Given this finding, the risk from disease, associated with S. marcescens, in the reintroduction of sand lizards from the captive colony was considered low, and conservation translocation continued. The practical, feasible disease risk management methods, described in this paper, can be utilised to reduce the risks from disease of conservation translocations and safeguard future populations.
Many tools have been developed to assess fall risk and support fall prevention for older adults, but the authors are unaware of any study that compares the performance of predictive algorithms based on major composite assessment tools and commonly used single assessment tools. This study compares the predictive performance of the algorithms for two composite fall risk assessment tools and four single fall risk assessment tools among community-dwelling Chinese older adults. A 12-month prospective study was conducted between April 2023 and June 2024 in Changsha, China. Two major composite assessment tools (Stopping Elderly Accidents, Deaths & Injuries [STEADI] and World Falls Guidelines [WFG] algorithms) and four single assessment tools (Stay Independent Brochure Questionnaire [SIB], Falls Efficacy Scale International [FES-I], Home Falls and Accidents Screening Tool [HOME FAST], and Timed Up and Go Test [TUGT]) were included. Primary performance measures included area under the receiver operating characteristic curves (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Among the 1,428 enrolled older adults, 1,237 participants completed the study. All ten algorithms from the two composite assessment tools showed notably low AUC (0.527-0.575), sensitivity (11.3-36.5%) and PPV (12.7-31.7%), but acceptably high specificity (78.9-96.2%) and NPV (87.2-92.9%) to predict both falls and fall-related injuries throughout the 12-month follow-up period. Among the ten algorithms, WFG algorithm 3 exhibited the best performance in predicting both falls (AUC = 0.573, 95% CI: 0.544, 0.600) and fall-related injuries (AUC = 0.575, 95% CI: 0.546, 0.602). Compared to five algorithms based on four single assessment tools, WFG algorithm 3 did not demonstrate significantly superior performance (p>0.05). The performances of the optimal algorithm in predicting 12-month falls and fall-related injuries among older adults from the two composite risk assessment tools were not better than those from four common single risk assessment tools.